Everyone shops using price comparisons. If you know that milk was $10 a gallon in Ripoff Mart and $3 a gallon in the supermarket, you’d never shop at Ripoff Mart. But look at how prices vary in hospitals.
For joint replacements, which are the most common hospital procedure for Medicare patients, prices ranged from a low of $5,304 in Ada, Okla., to $223,373 in Monterey, Calif. The average charge across the 427,207 Medicare patients’ joint replacements was $52,063.
Similar variation showed up for hospitals that treated particularly complicated cases of heart failure. At the high end, a hospital in Newark charged Medicare $173,250. At the low end, a hospital in western Tennessee submitted a bill for $7,304.
Hospital administrators are trying to tell us that the “chargemaster” prices don’t affect the average person, because those prices aren’t what insurers pay.
“The chargemaster can be confusing because it’s highly variable and generally not what a consumer would pay,” said Carol Steinberg, vice president at the American Hospital Association. “Even an uninsured person isn’t always paying the chargemaster rate.”
Bullshit. If nobody ever pays the chargemaster rate, why does the list exist? Note the word “generally”: That means, “We get to charge anyone stupid enough to fall for these bloated charges. You want to lower healthcare costs? Make insurance what it’s supposed to be, used only for the big charges like hospital stays, and force people to learn how to shop around for medical procedures. I already do that when I need to get an ultrasound or something similar. I have to pay x percent of the price, so I want to know what I’m paying before I go there.
And by the way, fellow Richmonders, if you lose a limb, don’t get it replaced in Richmond. At least, not without an investigation as to why it costs so much more here.
Virginia’s highest average rate for a lower limb replacement was at CJW Medical Center in Richmond, more than $117,000, compared with Winchester Medical Center charging $25,600 per procedure. CJW charged more than $38,000 for esophagitis and gastrointestinal conditions, while Carilion Tazewell Community Hospital averaged $8,100 in those cases.
I can understand charging higher prices if the quality of care is higher. But without customers able to see those charges and compare them with other healthcare providers, it’s a little difficult to verify that claim.
But don’t worry. Obamacare is coming to make things cheaper. Oh. Wait.
Unfortunately, most doctors and hospitals are not in the habit of giving out written estimates, or even oral estimates. They will specify the procedure and you sign giving consent. There’s nothing holding them legally to their quote, and I don’t even think the doctors have any idea what is finally charged. They’d just refer you to accounting or billing. Moreover, I’ve seen on TV investigative reports that the hospital charge sheets are top secret. Here’s an example of what I mean. Just a few months ago I had a small cavity filled. I asked for a quote from the billing person and she said it would be $75. Then when I rec’d the bill, it was $125. I asked the billing clerk about it, and she said that the dentist opted for the porcelain filler rather than the amalgam, and that added $50–yet it was not any harder or pricier to use either filler! Also, he didn’t ask me my preference beforehand.
Another weird story about medical costs is a sibling of mine went to the doctor with her daughter and she needed an anti-inflammatory. She was prescribed a pricey relatively new drug, but later found out insurance didn’t cover it. I told my sister if she lived in a city that wasn’t as rich, the doctor would have all the Big Box generic drug lists and would prescribe from it, since it has several anti-inflammatory choices. As it is, the doctors there think that price is no object for their clients–who wouldn’t be caught dead in a Big Box store anyway. But not everyone is rich who lives in a rich city.